| NPI | 1144210097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 112454) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 42161) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2021-08-20 |